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Ann Thorac Surg 2005;80:1981-1982
© 2005 The Society of Thoracic Surgeons

Correspondence

Loculated Neonatal Chylothorax Treated With Octreotide: Complete Recovery While on Unrestricted Full Fat Breast Milk

Charles C. Roehr, MD, Andreas Jung, MD, Oliver A. Curcin, MD, Hans Proquitte, MD, Hannes Hammer, MD, Roland R. Wauer, MD

Department of Neonatology, Charité Campus Mitte, Universitaetsmedizin Berlin, Schumannstr. 20-21, Berlin, 10098 Germany

(Email: christoph.roehr{at}charite.de).

To the Editor:

We have read the article by Hamdan and Gaeta [1] with great interest. Their report of successfully initiating breast milk in a child treated with octreotide (OCT) for postoperative chylothorax addresses an important question regarding the adjuvant treatment of such children. In such patients, medical treatment will almost exclusively include total parenteral nutrition (TPN); however, this bears the risk of infection and hepatotoxicity. Therefore, any means to avoid or shorten the duration of TPN would be welcomed. The article suggests a possible drug treatment of children with chylothorax. We would like to communicate our experience on the successful use of OCT in a child with primary chylothorax.

A male infant of 34 week gestation with severe fetal hydrops and bilateral pleural effusions was delivered by Caesarean section at our clinic. The initial management included mechanical ventilation, bilateral thoracostomy drains, and diuretic therapy. Enteral feeds were commenced on day 2 but had to be discontinued as chylous pleural effusions occurred. The patient was changed to total parenteral nutrition and chest drains remained in situ for 20 days. The TPN was gradually replaced by a low fat formula (Milupa Basic-F [Milupa, Friedrichsdorf, Germany]; fat content < 0.07 g/100 mL). On day 53 of life he had developed tachypnea along with an oxygen requirement. A chest ultrasound showed a loculated, mainly right-sided thoracic effusion, and biochemistry that confirmed chylothorax. We commenced subcutaneous injections of OCT (Sandostatin [Novartis-Pharma, Switzerland]) to circumvent the risks associated with repeated thoracocentesis. The starting dose (as described by Cheung and colleagues [2]) was 10 µg/kg/d; total daily doses were incremented by 5 µg/kg/d to as much as a maximum dose of 40 µg/kg/d. Treatment effect was monitored by regular chest ultrasound. Normal respiration was restored while enteral feeds could be maintained, more so that the child was successfully changed to full fat human milk. Daily blood glucose levels, stools, blood pressure, and weekly serum electrolytes, liver function tests, and weight gain remained normal throughout therapy. By day 69, no further effusions were found and OCT was discontinued on day 74. A spiral computed tomographic scan on day 76 was normal. At 6 months of age he was thriving well and showed normal longitudinal growth.

Treatment with OCT quickly reduced thoracic effusions in this patient, which prevented further thoracocentesis and permitted the initiation of human milk without evidence of serious side effects.


   References
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 References
 

  1. Hamdan MA, Gaeta ML. Octreotide and low-fat breast milk in postoperative chylothorax Ann Thorac Surg 2004;77:2215-2217.[Abstract/Free Full Text]
  2. Cheung Y, Leung MP, Yip M. Octreotide for treatment of postoperative chylothorax J Pediatr 2001;139:157-159.[Medline]



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Ann. Thorac. Surg., November 1, 2005; 80(5): 1982 - 1982.
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